| Référence associée : | | |
| Effects of Sexual Intercourse Patterns in Time to Pregnancy Studies .. cacher .... voir plus ..
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| Cumulative pregnancy rates in patients with apparently normal fertility and fertility-focused intercourse .. cacher .... voir plus ..
Fifty consecutive clients achieved pregnancy using a standardization modification of the Billings ovulation method (the Creighton Model Natural Family Planning System). Of 50 clients followed, 38 (76%) achieved pregnancy in the first cycle of fertility-focused intercourse, 45 of 50 (90%) achieved pregnancy by the third cycle and 49 of 50 achieved pregnancy by the sixth cycle (98%).
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| Hilgers TW, et al Cumulative pregnancy rates in patients with apparently normal fertility and fertility-focused intercourse. .. cacher .... voir plus ..
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| Timed intercourse for couples trying to conceive .. cacher .... voir plus ..
Background Background Fertility problems are very common, as subfertility affects about 10% to 15% of couples trying to conceive. There are many factors that may impact a couple s ability to conceive and one of these may be incorrect timing of intercourse. Conception is only possible from approximately five days before up to several hours after ovulation. Therefore, to be effective, intercourse must take place during this fertile period. Timed intercourse is the practice of prospectively identifying ovulation and, thus, the fertile period to increase the likelihood of conception. Whilst timed intercourse may increase conception rates and reduce unnecessary intervention and costs, there may be associated adverse aspects including time consumption and stress. Ovulation prediction methods used for timing intercourse include urinary hormone measurement (luteinizing hormone (LH), estrogen), tracking basal body temperatures, cervical mucus investigation, calendar charting and ultrasonography. This review considered the evidence from randomised controlled trials for the use of timed intercourse on positive pregnancy outcomes. Objectives Objectives To assess the benefits and risks of ovulation prediction methods for timing intercourse on conception in couples trying to conceive. Search methods Search methods We searched the following sources to identify relevant randomised controlled trials, the Menstrual Disorders and Subfertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, PubMed, LILACS, Web of Knowledge, the World Health Organization (WHO) Clinical Trials Register Platform and ClinicalTrials.gov. Furthermore, we manually searched the references of relevant articles. The search was not restricted by language or publication status. The last search was on 5 August 2014. Selection criteria Selection criteria We included randomised controlled trials (RCTs) comparing timed intercourse versus intercourse without ovulation prediction or comparing different methods of ovulation prediction for timing intercourse against each other in couples trying to conceive. Data collection and analysis Data collection and analysis Two review authors independently assessed trial eligibility and risk of bias and extracted the data. The primary review outcomes were cumulative live birth and adverse events (such as quality of life, depression and stress). Secondary outcomes were clinical pregnancy, pregnancy (clinical or self-reported pregnancy, not yet confirmed by ultrasound) and time to conception. We combined data to calculate pooled risk ratios (RRs) and 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I2 statistic. We assessed the overall quality of the evidence for the main comparisons using GRADE methods. Main results Main results We included five RCTs (2840 women or couples) comparing timed intercourse versus intercourse without ovulation prediction. Unfortunately one large study (n = 1453) reporting live birth and pregnancy had not published outcome data by randomised group and therefore could not be analysed. Consequently, four RCTs (n = 1387) were included in the meta-analysis. The evidence was of low to very low quality. Main limitations for downgrading the evidence included imprecision, lack of reporting clinically relevant outcomes and the high risk of publication bias. One study reported live birth, but the sample size was too small to draw any relevant conclusions on the effect of timed intercourse (RR 0.75, 95% CI 0.16 to 3.41, 1 RCT, n = 17, very low quality). One study reported stress as an adverse event. There was no evidence of a difference in levels of stress (mean difference 1.98, 95 CI% -0.87 to 4.83, 1 RCT, n = 77, low level evidence). No other studies reported adverse events. Two studies reported clinical pregnancy. There was no evidence of a difference in clinical pregnancy rates (RR 1.10, 95% CI 0.57 to 2.12, 2 RCTs, n = 177, I2 = 0%, low level evidence). This suggested that if the chance of a clinical pregnancy following intercourse without ovulation prediction is assumed to be 16%, the chance of success following timed intercourse would be between 9% and 33%.Four studies reported pregnancy rate (clinical or self-reported pregnancy). Timed intercourse was associated with higher pregnancy rates compared to intercourse without ovulation prediction in couples trying to conceive (RR 1.35, 95% CI 1.06 to 1.71, 4 RCTs, n = 1387, I2 = 0%, very low level evidence). This suggests that if the chance of a pregnancy following intercourse without ovulation prediction is assumed to be 13%, the chance following timed intercourse would be between 14% and 23%. Subgroup analysis by duration of subfertility showed no difference in effect between couples trying to conceive for < 12 months versus couples trying for ≥ 12 months. One trial reported time to conception data and showed no evidence of a difference in time to conception. Authors conclusions Authors conclusions There are insufficient data available to draw conclusions on the effectiveness of timed intercourse for the outcomes of live birth, adverse events and clinical pregnancy. Timed intercourse may improve pregnancy rates (clinical or self-reported pregnancy, not yet confirmed by ultrasound) compared to intercourse without ovulation prediction. The quality of this evidence is low to very low and therefore findings should be regarded with caution. There is a high risk of publication bias, as one large study remains unpublished 8 years after recruitment finished. Further research is required, reporting clinically relevant outcomes (live birth, clinical pregnancy rates and adverse effects), to determine if timed intercourse is safe and effective in couples trying to conceive.
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| Impact of instruction in the Creighton Model FertilityCare System on time to pregnancy in couples of proven fecundity: results of a randomised trial .. cacher .... voir plus ..
Background The Creighton Model FertilityCare System (CrMS) teaches women to identify days when intercourse is likely to result in pregnancy. We sought to assess the impact of the CrMS on time to clinically identified pregnancy (TTP), via per-cycle pregnancy rates (fecundability). Methods We conducted a parallel randomised trial at the University of Utah School of Medicine, 2003–2006. Women ages 18–35, in a relationship of proven fertility, who desired to conceive, were block-randomised, stratified for age, with allocation concealment by opaque sequentially numbered sealed envelopes. The control group received the advice to have intercourse 2–3 times per week, and the intervention group received CrMS instruction. All women were asked to begin trying to conceive starting the second cycle in the study and were followed actively up to 7 cycles, without blinding of research personnel. We calculated descriptive statistics and fecundability, and estimated Cox models for TTP. Registration: Clinicaltrials.gov NCT00161395 Results There were 143 women randomised: 71 to the control group (all analysed) and 72 to the CrMS group (69 analysed). The adjusted hazard ratio for the influence of CrMS on TTP was 0.86 (95% CI: 0.53, 1.38). Fecundability in cycles with intent to conceive was 31% in controls and 36% with CrMS (p=0.32). By the first cycle, fecundability was 17% in controls, and 4% with CrMS (p=0.02). No adverse events were reported. Conclusions We found no significant impact of CrMS on TTP or fecundability, but fewer of the women receiving CrMS conceived by the first cycle.
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| Impact of Instruction in the Creighton Model FertilityCare System on Time to Pregnancy in Couples of Proven Fecundity: Results of a Randomised Trial: Creighton Model and time to pregnancy .. cacher .... voir plus ..
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| Traitement de l'infertilité masculine .. cacher .... voir plus ..
Le traitement de l'infertilité masculine a lieu dans le cadre de la gestion de l'infertilité et doit également tenir compte de la fécondité de la femme.
Dans un certain nombre de situations, l'intervention médicale ou chirurgicale peut améliorer la concentration de spermatozoïdes, par exemple:
l'utilisation de la FSH chez les hommes souffrant d'hypogonadisme hypophysaire,
d'antibiotiques en cas d'infection
ou de corrections opératoires d'une hydrocèle, d'une varicocèle ou d'une obstruction du canal déférent.
Mais, dans la plupart des cas d'oligospermie, y compris sa forme idiopathique, il n'y a pas d'intervention médicale ou chirurgicale directement acceptée pour être efficace.
De manière empirique, de nombreuses approches médicales ont été essayées, y compris le citrate de clomiphène, tamoxifène, HMG, FSH, HCG, testostérone, vitamine E, vitamine C, anti-oxydants, carnitine, acétyl-L-carnitine, zinc, les régimes riches en protéines.
La thérapie combinée "Low dose Estrogen Testosterone Combination Therapy" peut améliorer le nombre de spermatozoïdes et la motilité chez certains hommes, y compris l'oligospermie sévère.
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| Traitement de l'azoospermie ou de l'oligospermie non-obstructive .. cacher .... voir plus ..
Certains hommes atteints d'azoospermie non obstructive peuvent avoir une correction de leur anomalie. Pour certains hommes, la solution est assez simple:
- Faire un changement de style de vie
- Changer un médicament
- Ou commencer à éviter certaines toxines. En outre, le système de reproduction est assez résistant; après une chimiothérapie ou une radiothérapie: le corps a juste besoin de temps pour se rétablir.
Mais il est également possible de recommander une intervention plus directe. Dans tous les cas, il faut 2-3 mois pour faire assez de sperme après avoir vu un avantage net.
traitement hormonal
En fonction de leurs niveaux existants, certains hommes atteints d'azoospermie non obstructive bénéficient d'un traitement avec certaines hormones, entraînant le développement du spermatozoïde vers leur spermozoide. Ces hormones incluent:
L'hormone folliculo-stimulante (FSH)
Gonadotrophine chorionique humaine (HCG)
Clomiphene
Anastrazole
Letrazole
Traitement d'un varicocèle
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| Référence associée : | | |
| Hilgers TW. Pregnancy and the timing of intercourse .. cacher .... voir plus ..
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| Intra-uterine insemination versus timed intercourse or expectant management for cervical hostility in subfertile couples .. cacher .... voir plus ..
Background Background The postcoital test has poor diagnostic and prognostic characteristics. Nevertheless, some physicians believe it can identify scanty or abnormal mucus that might impair fertility. One way to avoid hostile cervical mucus is intrauterine insemination. With this technique, the physician injects sperm directly into the uterine cavity through a small catheter passed through the cervix; the theory is to bypass the "hostile" cervical mucus. Although most gynaecological societies do not endorse use of intrauterine insemination for hostile cervical mucus, some physicians consider it an effective treatment for women with infertility thought due to cervical mucus problems. Objectives Objectives The aim of this review was to determine the effectiveness of intrauterine insemination with or without ovarian stimulation in women with cervical hostility who failed to conceive. Search methods Search methods We searched Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library Issue 3, 2008, MEDLINE (1966 to August 2008), EMBASE (1980 to August 2008), POPLINE (to August 2008) and LILACS (to August 2008). In addition, we contacted experts and searched the reference list of relevant articles and book chapters. Selection criteria Selection criteria We included randomised and quasi-randomized controlled trials comparing intrauterine insemination with intercourse timed at the presumed fertile period or expectant management. Participants were women with cervical hostility who failed to conceive for at least one year. Data collection and analysis Data collection and analysis We assessed the titles and abstracts of 396 publications and two reviewers independently abstracted data on methods and results from five studies identified for inclusion. The main outcome is pregnancy rate per couple. Main results Main results We did not pool the outcomes of the included six studies in a meta-analysis due to the methodological quality of the trials and variations in the patient characteristics and interventions. Narrative summaries of the outcomes are provided. Each study was too small for a clinically relevant conclusion. Only one of the studies provided information on important outcomes such as spontaneous abortion, multiple pregnancies, but none of studies reported on the occurrence of e.g. ovarian hyperstimulation syndrome. Authors conclusions Authors conclusions There is no evidence from the published studies that intrauterine insemination is an effective treatment for cervical hostility. Given the poor diagnostic and prognostic properties of the postcoital test and the observation that the test has no benefit on pregnancy rates, intrauterine insemination (with or without ovarian stimulation) is unlikely to be a useful treatment for putative problems identified by postcoital testing.
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| Pregnancy and the timing of intercourse .. cacher .... voir plus ..
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| Timing intercourse to achieve pregnancy: current evidence .. cacher .... voir plus ..
Physicians who counsel women for preconception concerns are in an excellent position to give advice to couples regarding the optimal timing of intercourse to achieve pregnancy. The currently available evidence suggests that methods that prospectively identify the window of fertility are likely to be more effective for optimally timing intercourse than calendar calculations or basal body temperature. There are several promising methods with good scientific bases to identify the fertile window prospectively. These include fertility charting of vaginal discharge and a commercially available fertility monitor. These methods identify the occurrence of ovulation clinically and also identify a longer window of fertility than urinary luteinizing hormone kits. Prospectively identifying the full window of fertility may lead to higher rates of conception. Proper information given early in the course of trying to achieve pregnancy is likely to reduce time to conception for many couples, and also to reduce unnecessary intervention and cost.
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| Vulvar mucus observations and the probability of pregnancy .. cacher .... voir plus ..
OBJECTIVE: To assess the day-specific and cycle-specific probabilities of
conception leading to clinical pregnancy, in relation to the timing of
intercourse and vulvar mucus observations.
METHODS: This was a retrospective cohort study of women beginning use of the
Creighton Model Fertility Care System in Missouri, Nebraska, Kansas, and
California. Data were abstracted from Creighton Model Fertility Care System
records, including women's daily standardized vulvar observations of cervical
mucus discharge, days of intercourse, and clinically evident pregnancy
(conception). Established statistical models were used to estimate day-specific
probabilities of conception.
RESULTS: Data were analyzed from 1681 cycles with 81 conceptions from 309
normally fertile couples (initially seeking to avoid pregnancy) and from 373
cycles with 30 conceptions from 117 subfertile couples (who were initially trying
to achieve pregnancy). The highest probability of pregnancy occurred on the peak
day of vulvar mucus observation (.38 for normally fertile couples and.14 for
subfertile couples). The probability of pregnancy was greater than.05 for
normally fertile couples from 3 days before to 2 days after the peak, and for
subfertile couples from 1 day before to 1 day after the peak. The cycle-specific
probability of conception correlated with the quality of mucus discharge in
normally fertile couples but not in subfertile couples.
CONCLUSION: Standardized vulvar observations of vaginal mucus discharge identify
the days with the greatest likelihood of conception from intercourse in normal
fertility and subfertility and provide an indicator of the overall potential for
conception in a given menstrual cycle in normal fertility.
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Antécédents médicaux ou chirurgicaux